[Analysis of the results of femoral lengthening in 34 children and adolescents].

The authors have evaluated a complex of 34 femurs prolongated in the period 1978-1988 by means of Wagner (26), Ilizarov (5) or bisegmental external fixation device of their own design (3). The whole group comprised 13 boys and 21 girls in the age group ranging from 6.5 to 17.25 years of age. In 13 cases the shortening of the extremity was congenital, in 21 cases it was of secondary nature. All usual data were observed and the quality of healing in the distraction gap was assessed by means of x-ray check up. The average shortening in the above mentioned group of patients ranged from 40 to 50 mm, the average prolongation of the bone was 40 mm. Subsequent osteosynthesis by means of a plate was carried out and bone grafts were applied in one third of the children. The healing of the bone gap was more rapid in children up to 12 years of age. The differentiation of medullary canal and corticalis occurred on average 15 months after operation and the normal shape of the bone was restored 22 months after operation. Full body weight bearing was allowed in case of the Wagner device on average after 11 months, in case of the Ilizarov's device after 14.5 months, but in case of the bisegmental device as early as 6 months after the accomplishment of the prolongation phases. The complications during the prolongation comprised angulation of the bone (3), dislocation of patella (2), reduction of the range of motion of the knee (4). The complications after the removal of the device included traumatic fracture (4), fatigue fracture (3), angulation of femur (1). On the basis of the analysis of the material the authors recommend in case of these patients to concentrate attention in the following direction: 1. In cases where the shortening is evident the operation should not be delayed and the femur should be prolonged as early as until 12th year of age of the patient. 2. The prolongation should be performed only by means of a stable external fixation device. Ilizarov's device is not in this case desirable. Where the size of the femur is suitable it is recommended to apply the bisegmental device. 3. Osteotomy should be longer and oblique and the contact of bone fragments should be maintained. 4. The prolongation should start no sooner than 7-10 days after operation to enable the bone callus to be prolongated to get organized.(ABSTRACT TRUNCATED AT 400 WORDS)